Provider Demographics
NPI:1518417880
Name:HALL, KELLY LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 E CHAPARRAL RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7754
Mailing Address - Country:US
Mailing Address - Phone:717-487-6665
Mailing Address - Fax:
Practice Address - Street 1:7602 E CHAPARRAL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7754
Practice Address - Country:US
Practice Address - Phone:717-487-6665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ94-3019135OtherPHARMACY TAX ID